- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,795.79 / $13,904.40 / $22,546.80
| Facility | | $8,795.79 | $13,904.40 | $22,546.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,821.10 / $12,009.40 / $27,645.59
| Facility | | $9,821.10 | $12,009.40 | $27,645.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $10,562.06 / $19,667.39
| Facility | | $100.00 | $10,562.06 | $19,667.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,196.75 / $15,178.49 / $25,600.79
| Facility | | $10,196.75 | $15,178.49 | $25,600.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,132.70 / $19,069.40 / $22,379.56
| Facility | | $13,132.70 | $19,069.40 | $22,379.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,791.79 / $12,559.39 / $25,824.08
| Facility | | $8,791.79 | $12,559.39 | $25,824.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.00 / $11,299.40 / $23,132.95
| Facility | | $5,693.00 | $11,299.40 | $23,132.95 |